Mechanisms of Exercise Capacity Improvement after Cardiac Rehabilitation Following Myocardial Infarction Assessed with Combined Stress Echocardiography and Cardiopulmonary Exercise Testing
| Autor: | Andrzej Budaj, Tomasz Jaxa-Chamiec, Beata Zaborska, Maciej Tysarowski, Krzysztof Smarż |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Ejection fraction business.industry stress echocardiography Cardiac index VO2 max General Medicine Stroke volume medicine.disease Article exercise capacity cardiac rehabilitation Internal medicine Arteriovenous oxygen difference Heart rate Stress Echocardiography Cardiology cardiopulmonary exercise testing Medicine Myocardial infarction business |
| Zdroj: | Journal of Clinical Medicine Volume 10 Issue 18 Journal of Clinical Medicine, Vol 10, Iss 4083, p 4083 (2021) |
| ISSN: | 2077-0383 |
| Popis: | Cardiac rehabilitation (CR) is indicated in all patients after acute myocardial infarction (AMI) to improve prognosis and exercise capacity (EC). Previous studies reported that up to a third of patients did not improve their EC after CR (non-responders). Our aim was to assess the cardiac and peripheral mechanisms of EC improvement after CR using combined exercise echocardiography and cardiopulmonary exercise testing (CPET-SE). The responders included patients with an improved EC assessed as a rise in peak oxygen uptake (VO2) ≥ 1 mL/kg/min. Peripheral oxygen extraction was calculated as arteriovenous oxygen difference (A-VO2Diff). Out of 41 patients (67% male, mean age 57.5 ± 10 years) after AMI with left ventricular ejection fraction (LVEF) ≥ 40%, 73% improved their EC. In responders, peak VO2 improved by 27% from 17.9 ± 5.2 mL/kg/min to 22.7 ± 5.1 mL/kg/min, p < 0.001, while non-responders had a non-significant 5% decrease in peak VO2. In the responder group, the peak exercise heart rate, early diastolic myocardial velocity at peak exercise, LVEF at rest and at peak exercise, and A-VO2Diff at peak exercise increased, the minute ventilation to carbon dioxide production slope decreased, but the stroke volume and cardiac index were unchanged after CR. Non-responders had no changes in assessed parameters. EC improvement after CR of patients with preserved LVEF after AMI is associated with an increased heart rate response and better peripheral oxygen extraction during exercise. |
| Databáze: | OpenAIRE |
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